Implementation of a Handoff Report Tool Among Trauma Intermediate Care Nurses

Abstract

Problem and Purpose: An estimated 80% of serious errors and sentinel events are attributable to miscommunication during patient handoffs. Since 2010, the JCAHO has required that during transitions in care, healthcare providers engage in handoff communication between the giver and receiver of hospitalized patients. Inadequate patient handoff communication remains a key contributor to medical errors, preventable adverse events, and sentinel events. The illness severity, patient summary, action list, situational awareness and contingency planning, and synthesis by receiver (I-PASS) method was created with use of a tool to improve handoff communication practices. The handoff tool was designed to decrease medication errors and enhance the safety and quality of patient care. Among nurses working in a multi-trauma intermediate care unit, a standardized patient handoff process with the critical elements of communication was lacking at a tertiary academic hospital in the Mid-Atlantic region. The nurse manager of a trauma intermediate care unit reported large nursing staff turnover and concerns about novice staff members’ handoff communication effectiveness. With high acuity and a complex patient population, effective handoff is essential to maintaining patient safety as well as minimizing omissions in care and potential errors. Methods: The purpose of this Doctor of Nursing Practice quality improvement project was to implement and evaluate the I-PASS handoff tool for perceived handoff report communication among nurses. Compliance with the verbal communication and written report tools were audited weekly. A pre/post perceived handoff communication survey was also distributed prior to and after the 15-week project period. Results: Findings indicated that staff compliance with the I-PASS handoff report tool reached or exceeded the goal of 75% from week five to week 14. When using the handoff report tool, perceived handoff communication increased significantly by 9% post implementation (p < 0.05). The medication error event rate declined by 47% during the implementation period. Conclusions: The I-PASS handoff report tool improved perceived handoff communication among nurses. Subsequent quality improvement projects are recommended to evaluate the use of adapted unit-specific I-PASS handoff report tools to further validate the method’s effectiveness and potential to improve medication-related and patient safety events.